Ophthalmic Artery Pressure Cooker Technique for Management of Anterior Cranial Fossa Dural AVF

Introduction: Anterior cranial fossa dural arterio-venous fistulas (ACF-dAVFs) are rare with high incidence of intracranial hemorrhage. Endovascular treatment experience of ACF-dAVF is limited. We describe the Pressure Cooker Technique to achieve safe embolization with complete AVF closure of two cases of ACF-dAVF.

Method(s): Two cases of ACF-dAVF with feeders from ophthalmic artery were embolized. Sonic microcatheters (1.5/1.2F) were navigated into arterial feeder close to nidus. Marathon 1.3F was taken distal to origin of retinal artery, multiple detachable coils were placed to form a plug. Onyx 18 and Squid 12 were injected through the Sonic microcatheters in a controlled fashion. No reflux proximal to coils was noted. Check angiogram revealed closure of fistula with patent retinal vascularity.

Result(s): Complete closure of dural AVF was achieved by Onyx Cast achieved with good antegrade penetration. No reflux into proximal ophthalmic artery was noted. Postprocedure retinal vascularity/ciliary blush was maintained with normal visual acuity in postoperative period.

Conclusion(s): We describe pressure cooker technique with coils to achieve complete AVF closure. Pressure Cooker Technique can be a viable and safe option in endovascular management of AC dAVF.

Publication History

Article published online:
09 February 2023